When should I consider starting antiepileptic medication in a patient who has had a first seizure?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 16 August 2025Updated: 16 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Consider initiating antiepileptic medication after a first unprovoked seizure if any of the following apply: an examination identifies signs of neurological deficit, the electroencephalogram (EEG) shows unequivocal epileptic activity, the person or their family or carers consider the risk unacceptable after a discussion of the risk of further seizures, or brain imaging shows a structural abnormality .

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